Provider Demographics
NPI:1902062821
Name:DILISIO, ABRA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABRA
Middle Name:J
Last Name:DILISIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E 96TH ST
Mailing Address - Street 2:APARTMENT 17A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3839
Mailing Address - Country:US
Mailing Address - Phone:248-217-4590
Mailing Address - Fax:
Practice Address - Street 1:3905 61ST ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3566
Practice Address - Country:US
Practice Address - Phone:718-899-5437
Practice Address - Fax:718-247-5727
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054342-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist